An Analysis of Critical Success Factors for Multinational Medical Technology Companies’ Long-term Sustainability in India

Due to the Global economic crisis, multi-National manufacturers of high-tech medical equipment companies are expanding their sales & marketing activities in India to increase their business for their survival considering the huge market opportunity backed by the stable economic condition of India prevailing as of date. The study will analyze the strategies of Multinational Medical Technology (Med-Tech) companies in five Metro Cities in India for achieving their business goal encasing the prevailing advantageous economic conditions of India backed by huge market potential & constant growth of the healthcare industry


Introduction
The world has seen an economic crisis that started in July 2007 with the burst of the housing bubble in the USA followed by the Share Market fall in 2008. Many countries' economies across the globe were badly affected & some could not yet even come out from the shocks of the 2008 recession (Edwin Egboro, 2016). Failure in corporate governance from the statutory authority on financial dealings, failure in risk analysis by financial institutes, & exorbitant salaries drawn by the executives is also responsible for the financial crisis (Grant Kirkpatrick,2009). All of a sudden, Corona Virus spread across the globe impacting the socioeconomic condition of the world. When the world economy was just started recovering after the severe impact of the Pandemic for consecutive two years, the Russia-Ukraine war jolted the economy again. More than 45 million people from over 43 nations are affected by this war, millions of people lost their jobs and are even uncertain about their basic needs of shelter & food. Currently, India is in better economic condition compared to Europe & USA mainly for: • India is less dependent on global inflow in the economyonly 20% of GDP comes from external trade. • Over 139 Crore population available for domestic products & services.
• Due to competitive prices, export income from services remains almost unchanged.
• There is stringent control by the statutory authority like the Reserve Bank of India (RBI), Insurance Regulatory and Development Authority of India (IRDA), Securities and Exchange Board of India (SEBI), etc. on compliance with financial transactions in India.
for purchasing capital items but the budget for maintenance of the capital items after the warranty period is negligible compared to the capital items. To overcome this issue Govt Hospitals are now floating tenders with 5 to 7 years built-in warranty cost. This in turn helps the MedTech companies to generate service revenue for additional warranty periods in advance along with the cost of capital equipment. To win the tender from Govt Hospitals, the MedTech Companies use all sorts of marketing strategies to convince the actual users & decision-makers to incorporate their unique features in the technical specifications of tenders. At times the government hospital ends up buying high-tech medical equipment with features that are not essential for regular use or need special training for proper utilization and/or very high maintenance cost. To overcome this situation Govt Hospitals are now encouraging Public-Private-Partnership (PPP) programs. Under this PPP program, MedTech Companies are asked to take the responsibility of supplying, installing, maintaining & utilize the equipment to its fullest capabilities on a revenue-sharing basis. This gives an additional avenue source to the Medical Equipment suppliers with the built-in interest cost in the revenue-sharing model considering the significant interest rate difference between India and developed countries. The drawback of this model for medical colleges is that students are not getting the opportunity of exposure to high-tech equipment as most cases they are not allowed to handle these sophisticated types of equipment by private partners for commercial reasons.

Private Sectors
Private Sectors are segmented into standalone Diagnostic Centres, Chains of Diagnostic Centres operating in more than one city, Standalone Nursing Homes, Standalone Speciality Hospitals, Chains of Speciality Hospitals having operations in more than one city, Standalone Super Speciality Hospitals, and Chains of Super Speciality Hospitals having operations in more than one city. Multinational MedTech companies formulate their organizational structure & marketing strategy based on their internal organizational goal vis-vis the healthcare service provider's specific requirement. The old school of sales i.e., selling own products to the prospective customer is no more valid for the highly competitive medical industry. The customers are knowledgeable and demanding & can fetch any piece of information & cross-check the claim of the suppliers within a few minutes through net surfing. In modern sales, MedTech companies have to unleash the need or problems of the customer and provide solutions accordingly. MedTech Companies take the consultative approach instead of just a regular sales approach. The procurement process is becoming more structured & multidimensional for the healthcare industry. The Complexity of sales is increasing with the involvement of multiple stakeholders & decision-makers in the procurement process. Customers are taking the decision based on a multi-dimensional angle starting from the country of origin of the products (particularly after the pandemic & Russia-Ukraine War), Life-Cycle Cost, Turnaround-time (TAT) of Service Delivery, Post sales Application Support, uniqueness of the products to get a marketing edge over the competitors, marketing support of vendors to the customers marketing team for improving patient throughput through referrals for faster return on investment(ROI), future upgrade path & the cost of the upgrade, the commitment of vendors, accessibility of vendors top management for crisis resolution, credit facility or differed payment option with a lucrative interest rate are few major dimension.
Addressing the above requirements is not possible by any individuals from the vendor's side & it needs the support of the entire organization. Multi-National MedTech companies, therefore, organize strategic Key Account Management (KAM) Teams with a holistic approach to combat competition to maintain their eligible market share.

Gap Analysis
The entire recommendation of this model is mostly based on theory; the effectiveness of this model is yet to be tested practically. In total 8 hypotheses are tested to conclude the assumption i.e.: a. Hypothesis One -A marketing organization's relational bonding with the customer improves the chances of a Key Account game plan. b. Hypothesis Two-customer's top-level commitment in relational stake with vendors improves the chances of the Key Accounts game plan.
c. Hypothesis Three -availabilities of alternative options to customers reduces the chances of Key Account's success. d. Hypothesis Four-Chances of Key Account's success reduce with the improvement of customers' knowledge about the staff handling the account. e. Hypothesis Five-Chances of Key Account's success reduces with the perception of customers that there is lacking metamorphosis from vendors. f. Hypothesis Six-Chances of Key Account's success reduces with the enhancement of the disappointment of customers with vendors. g. Hypothesis Seven-Chances of Key Account's success increase with the enhanced bonding among individual & societal levels. h. Hypothesis Eight -Chances of Key Account's success decrease with the external environmental impact. 29 Successful Key accounts (the business was consistent for the past 10 years) & 28 dissolved Key Accounts (buyers did not place a higher value of the order with the Key Account Firm) were considered for the study. The questionnaire was developed to get the answer to whether the marketing organization has an agreement or disagreement with pertinent questions related to their relational bonding with customers, customer commitment, availability of alternatives to customers, customers' knowledge about the staff handling the account, level of the metamorphosis of vendors, disappointment level of customers, individual & societal bonding, impact of external environmental changes. Collected data were analyzed using the co-relation method & were explained in tabular format. Outcomes reveal that seller's strength of proximity with customers, salespersons bonding with a customer at individual & societal levels, customer's disappointment with vendors, and the impact of external environmental changes are fundamental driving forces for the success of Key Account. The author suggested that for minimizing the risk, the selling companies should create a department that will monitor the competitors' activities & the impact of external changes on business. Gap Analysis: The literature is silent about the process of retaining the Key account as the initial success of the Key account decreases over time of establishing the relation. Das Narayandas,(1998) this literature explained the importance of maintaining the customer relationship which benefits the vendors to keep their customers loyal to them. The literature also talks about the importance of measuring the benefits of holding the customers for vendors. The study explains that the customer holding program has many variables which influence the Benefits of the Customer Retention (BCR) scale. Customers with a higher BCR scale on the ladder, improve the customer willingness to pay a better price to their preferred vendors, do not easily get biased by competitors selling speeches, do not change their loyalty easily, resist the enticement of competitors, and tend to ignore any negative opinion of external experts. If these customers are happy with products and do not perceive any risk with the products, generally do not easily look for information to change their loyalty to their preferred vendor's products & it is just the opposite if they have a negative opinion. Loyal customers agreed to wait for the delayed supply from their preferred vendors instead of procuring the same from others. A positive recommendation from existing customers is important in marketing, the loyal customers willingly recommend the products of their preferred vendors to others without hesitation. According to this study, depending on the BCR scale the loyalty of customers changes from upper to lower levels of the ladder. The satisfaction level of customers plays a vital role in business, extreme unsatisfied customers may influence the internal decision-making on procurement against the preferred vendors and/or may bias the probable customer to look for alternatives. This action of customers may not be revealed on a linear scale, it would be displayed in stages. For the customer withholding dimension, vendors have to concentrate on & improve the other dimension in addition to customer satisfaction to change the stages of the BCR ladder. The BCR scale will help vendors to analyze their ROI on individual customers which in turn helps them to strategize an action plan to attain their goal. The critical parameters that impact the BCR scale are the superiority of goods, trust between buyers & sellers, disclosure with competitors, customers with sensitivity to price, and cost of switching vendors. The limitation of the research is the study was done particularly in the PC Industry; it should be done holistically across other industries. Ryan R. Mullins et al. (2014): this study talks about the accuracy of the Salesperson's perceptions about the quality of the relationship with the customer vis-vis customer`s perceptions of the salesperson & the bearing of the same on the profitability of the organization. Any business-house formulate its marketing strategies based on the input of its customer-facing field salespersons' feedback on their customers. This feedback varies depending on sales person's basic characteristics like whether the salesperson is a potent salesperson or a customer-centric salesperson. A potent salesperson tends to maintain his self-esteem, and project his customer relationship on a higher scale & the customer-centric salesperson gives proper concentration on the customer's negative feedback which impacts his quality of relationship with the customer not positively. The manager of the salesperson should compare this with feedback from customers, compare, and measure the feedback of the salesperson & calibrate the same by applying the control system based on behavior. The manager should guide his team to take customer feedback minutely without any personal bias. This helps both potent & customer-centric salespersons to analyze their customers, and formulate & bring back the right perspective to their organization. The study states that salesperson inaccuracy in judging customer in the initial stage impact the customer relationship which finally affects the profitability of the organization. Managers should deploy experienced salespeople at this stage to build customer relationships. This study also reveals that the deployment of more potent salespeople or over-customer-centric salespeople in new accounts may be counterproductive for the organization of their probable biased judgemental attribute. The salesperson can bring substantial profit if they can analyze the quality of customer relationships from the right perspective & can retain the customer for a longer period. The manager should empower the salesperson to deploy resources for relationshipbuilding activities with high-potential customers. The study is silent about the training process for updating the perception quality of salespeople to analyze the potentiality of customers & their decision criteria. Nektarios Tzempelikosa and Spiros Gounarisb(2013): this literature explains the empirical survey done with 304 respondents to see the effect of the Key Account Management Orientation(KAMO) concept which blends the numbers of ethos to be cultivated by the vendors for successful KAM operation. The study also inspects the impact of KAMO on organizations' commercial & non-commercial performance, which is pertinent to the organization's wider relational marketing standpoint. There are a few dimensions revels by the study, 1 st dimension is a set of ethos comprising of (1) customer orientation, (2) interfunctional coordination, and (3) top management commitment to developing KAM programs. The 1 st dimension set displays the keenness of vendors to acquire the required expertise for recognizing and allocating resources to the key account based on their specific requirements. The 2 nd dimension is the set of ethos that exhibit the behavior of the vendor's practice with their KAM activities. This ethos comprises of engagement of higher management of the organization in the KAM exercise, the vendor's intention & ability to cope with the specific requirement of customers, and holistic support from the entire organization Volume  The study suggests that TM should actively engage in shaping the culture of the organization which adds value to identifying the prospects and scanning pertinent intelligence. To shape the expected culture of the organization, TMs have to manifest their concern in every precious intelligence available in the organization. TMS, at times, have to be skeptical & make disperse the information that they check. To remove internal resistance, TMs have to convince & earn the confidence of the Key Account Manager & his team about the rationale of the decision taken for protecting the companies' greater interests. How TM can shape the Organizational & its environment to improve the market analysis? TMS to interact with the respective managers responsible for Key Account to understand their perception of the existing supply options, and probable solutions to mitigate the problems that occurred. Competitors' weaknesses & own companies' advantages to be put into proper perspective to the Top Managers of The Key Account to get price premium or to downsize the requirements/specs of customers. TMS needs to involve personally in the deal to understand the attractiveness of the deal taking into consideration the holistic approach of the value proposition and companies' internal goal. Accordingly, TMs have to guide the KA managers & their teams to redirect the unattractive deal to competitors and grab the attractive deal in their favor without affecting the relationship between KAM partners.

Gap Analysis,
The study is silent about service delivery which is very crucial for retaining KAM partners.

Gap Analysis
The research is silent about the impact of relationships on the commercial & non-commercial achievements of KAM partners.

Research Methodology
The exploratory method has been followed in this study. The study is based on a combination of Qualitative & Quantitative Data. Primary Data has been collected through coded questionnaires & semi-structured personal Interviews. Open Probe & close probe method has been used for collecting the information. A total of twenty-five Multinational Medical Technology (MedTech) companies were selected for the study who are having operations in more than one metro city for a minimum of three years in India. Sectors considered for the study were, Radiology. Oncology, Anaesthesia & Critical Care, Invitro Diagnostics, USG & Colour Doppler. A total of 101 qualified responses were considered for the study. Secondary data has been collected through Extensive Literature reviews, journals, books, and Govt Reports, to explore the research gap pertinent to existing studies.     The result of the Pearson Chi-Squire test proves that overseas visitors of MedTech company's involvement & interaction have a significant impact on the business loss of MedTech Companies. Hence Null-hypothesis rejected and the alternative hypothesis was accepted. Conclusion, study reveals that multinational MedTech companies are ensuring service delivery turnaround time (TAT), a critical success factor for the long-term sustainability of MedTech companies in India. MedTech companies are so serious about increasing the market in India due to the shrinkage in the market in the USA & Europe owing to the global economic crisis, the higher management of India is not only directly involved & interacting with the customer, but they are involving their foreign counterpart also to interact with the customers to build the relationship for achieving their business goal.